[Anoplasty with House advancement flap for anal stenosis after hemorrhoidectomy. Report of a clinical case]. / Plastica anale con lembo di scorrimento tipo "house flap" per stenosi anale post emorroidectomia. Presentazione di un caso clinico.

Anorectal strictures may occur after anorectal surgery and in particular after surgical haemorrhoidectomy. Anal examination under general anaesthesia was recommended to evaluate the stricture and to choose the appropriate technique. The house advancement flap has been recently proposed for postsurgical anal stenosis repair. The house flap receives its blood supply through unnamed vessels extending through a fatty pedicle from the underlying external sphincter muscle and not from a skin or mucosal bridge like the other common flaps (Y-V and mucosal advancement flap). The aims of this study were firstly to report a case of post-haemorrhoidectomy anal stenosis in a 68-year-old man treated in our institution by house advancement anoplasty and secondly to evaluate the efficacy and safety of this new technique. The technique was totally successful in alleviating anal stenosis and maintaining faecal continence. House advancement anoplasty should be part of the armamentarium of colon and rectal surgeons for treating severe anal stenosis.

Inorganic mercury in the rock pool environment (Ligurian Sea).

In the present study the mercury concentration has been investigated in three components of a rock pool environment of Genoa Nervi (Ligurian Sea): water, particulate matter and Tigriopus fulvus (Harpacticoid copepod). The influence of some parameters (pH, temperature, salinity, rainfall) on mercury concentration has been evaluated. These data show that the mercury concentration is greater in Tigriopus males than in females and that the concentration also depends on temperature variations.

[Definite colostomy using a circular stapler: a technique to be reconsidered]. / La colostomia definitiva mediante stapler circolare: una tecnica da riconsiderare.

Personal experience on a particular utilization of circular stapler is reported. At the beginning the fast and easy execution emphasized its use. However, the constant appearance of a late complication was observed, i.e. the progressive stenosis of the stoma. This event occurred even when maximal size of the instrument was used and it reappeared after repeated procedures of instrumental or surgical dilatation. The effective validity of this technique was evaluated by the Authors. On the other hand, the Burk alternative technique, with a second purse-string on the cutaneous ring seems to prevent the stenosis. However, it is slow and difficult as traditional procedure. The causes of the neostoma stenosis performed by circular stapler, reported by the Authors in 100% of cases, are easily explained with the absence of biological barrier of colonic mucosa that normally prevents excessive tissue growth.

[Critical considerations on circular staplers]. / Alcune considerazioni critiche sugli staplers circolari.

After a careful review of the literature and a critical evaluation of personal experience on stapling technics in visceral anastomoses, some critical considerations on circular devices are reported. The Authors emphasize the well known qualities of staplers which brought to their routine use in digestive surgery. Some complications exclusively due to an "imperfect" firing of the instrument are then reported. Personal experience on a particular utilization of circular stapler for definitive colostomy is also reported. The Authors finally suggest some simple technical improvements.